Heart Failure

Topic Overview

What is heart failure?

Heart failure means that your heart muscle doesn't
pump as much blood as your body needs. Failure doesn't mean that your heart
has stopped. It means that your heart is not pumping as well as it
should.

Because your heart cannot pump well, your body tries to
make up for it. To do this:

Your body holds on to salt and water. This increases the
amount of blood in your bloodstream.

Your body has an amazing ability to make up for heart
failure. It may do such a good job that you don't know you have a disease. But
at some point, your heart and body will no longer be able
to keep up. Then fluid starts to build up in your body, and you have symptoms
like feeling weak and out of breath.

This fluid buildup is called
congestion. It's why some doctors call the disease congestive heart failure.

Heart failure usually gets worse over time. But treatment can
slow the disease and help you feel better and live longer.

What causes heart failure?

Anything that damages
your heart or affects how well it pumps can lead to heart failure. Common causes of heart failure are:

Disease of the sac around the heart (pericardial disease), such
as
pericarditis.

A slow, fast, or uneven heart rhythm (arrhythmia).

A heart problem that you were born with (congenital heart defect).

Long-term alcohol abuse, which can damage your heart.

What are the symptoms?

Symptoms of heart failure
start to happen when your heart cannot pump enough blood to the rest of your
body. In the early stages, you may:

Feel tired easily.

Be short of breath when you exert
yourself.

Feel like your heart is pounding or
racing (palpitations).

Feel weak or dizzy.

As heart failure gets worse, fluid starts to build up in
your lungs and other parts of your body. This may cause you to:

Feel short of breath even at
rest.

Have swelling (edema), especially in
your legs, ankles, and feet.

Gain weight. This may happen over just
a day or two, or more slowly.

Cough or wheeze, especially when you
lie down.

Need to urinate more at night.

Feel bloated or sick to your stomach.

If your symptoms suddenly get worse, you will need
emergency care.

How is heart failure diagnosed?

Your doctor may
diagnose heart failure based on your symptoms and a physical exam. But you will
need tests to find the cause and type of heart failure so that you can get the
right treatment. These tests may include:

Echocardiogram

An echocardiogram is the best and
simplest way to find out if you have heart failure, what type it is, and what
is causing it. Your doctor can also use it to see if your heart failure is
getting worse.

This test can measure how much blood your heart pumps to your body.
This measurement is called the
ejection fraction. If your ejection fraction gets
lower and you are having more symptoms, it means that your
heart failure is getting worse.

How is it treated?

Most people with heart failure need to take several
medicines. Your doctor may prescribe medicines to:

Reduce symptoms so you feel better.
These drugs include diuretics (water pills), digoxin, and potassium.

Treat the cause of your heart
failure.

It is very important to take your medicines exactly as
your doctor tells you to. If you don't, your heart failure could get worse.

Pacemaker or defibrillator

You might need to have a pacemaker or a defibrillator if you have a
problem with your heart rhythm. These help your heart keep a steady
rhythm.

Care at home

Lifestyle changes are an important part of treatment.
They can help slow down heart failure. They may also help control other
diseases that make heart failure worse, such as high blood pressure, diabetes,
and coronary artery disease.

The best steps you can take are to:

Eat less salt (sodium). Sodium causes your body to retain water and makes it
harder for your heart to pump. Your doctor may also ask you to
limit how much fluid you drink.

Get regular exercise. Your doctor can
tell you what level of exercise is safe for you, how to check your
pulse, and how to know if you are doing too much.

Take rest breaks during the day.

Lose weight if you are overweight. Even
a few pounds can make a difference.

To stay as healthy as possible, work closely with your
doctor. Have all your tests, and go to all your appointments. It is also
important to:

Talk to your doctor before you take any
new medicine, including nonprescription and prescription drugs, vitamins, and
herbs. Some of them may make your heart failure worse.

Keep track of your symptoms. Weigh yourself at the
same time every day, and write down your weight. Call your doctor if
you have a sudden weight gain, a change in your ability to exercise, or any
sudden change in your symptoms.

What can you expect if you have heart failure?

Medicines and lifestyle changes can slow or even reverse heart failure
for some people. But heart failure often gets worse over time.

Early on, your symptoms may not be too bad. As heart failure
gets worse, you may need to limit your activities.
Treatment can often help reduce symptoms, but it usually doesn't get rid of
them.

Heart failure can also lead to other health problems. These
may include:

Your doctor may be able to give you medicine or other
treatment to prevent or treat these problems.

Heart failure can
get worse suddenly. If this happens, you will need emergency care. To prevent
sudden heart failure, you need to avoid things that
can trigger it. These include eating too much salt, missing a dose of your
medicine, and exercising too hard.

Knowing that your health may get worse can be hard. It
is normal to sometimes feel sad or hopeless. But if these feelings last, talk
to your doctor. Antidepressant medicines, counseling, or
both may help you cope.

Health Tools

Health Tools help you make wise health decisions or take action to improve your health.

Decision Points focus on key medical care decisions that are important to many health problems.

Certain triggers,
such as too much sodium or not taking medicines the right way, may
suddenly make heart failure worse. This can sometimes cause deadly
problems such as
pulmonary edema or
cardiogenic shock.

Symptoms

At first you may not have any
symptoms from heart failure. For a while, your heart and body can make up for heart failure. For example, your heart can pump faster and pump more blood with each beat. This is called compensation.

But as your heart has more
trouble pumping enough blood to your body, you will likely have symptoms. These symptoms may get worse or change if your heart failure gets worse.

Symptoms of heart failure
start to happen when your heart can't pump enough blood to the rest of your
body. In the early stages, you may:

As heart failure gets worse, fluid starts to build up in
your lungs and other parts of your body. This may cause you to:

Feel short of breath even at
rest.

Have swelling (edema), especially in
your legs, ankles, and feet.

Gain weight. This may happen over just
a day or two, or more slowly.

Cough or wheeze, especially when you
lie down.

Need to urinate more at night.

Feel bloated or sick to your stomach.

How doctors talk about heart
failure

Heart failure is grouped—or
classified—according to symptoms.
Your treatment is based partly on what class of symptoms you
have.

There's also another way to define heart failure.
It's based on the
stages you might go through as your heart failure gets
worse. Your doctor also may make treatment choices based on your stage of heart
failure.

Symptoms of sudden heart failure

Sometimes your symptoms may get worse very quickly. This is
called sudden heart failure. It causes fluid to build up in your lungs, causing
congestion. (This is why the problem is often called congestive heart
failure.) Symptoms may include:

More information

What Increases Your Risk

Your risk for having heart failure is higher if you have certain risk factors. A risk factor is anything that increases your chance of having a particular problem.

Heart failure
is usually caused by another health problem, often
coronary artery disease or high blood pressure. So anything that
increases your risk for one of those problems also increases your risk for
heart failure.

Risk factors for
coronary artery disease and heart attack include smoking, having high cholesterol or
diabetes, and having a family history of heart
disease.

Risk factors for
high blood pressure include being overweight, being inactive, and having a family history
of high blood pressure.

Risk factors for
heart valve disease include older age and an infection of the valves.

An
echocardiogram is the best and simplest way to
diagnose heart failure. It also can help guide
treatment.

Sometimes, because of a person's weight,
breast size, or severe lung disease, an echocardiogram might not be accurate.
If that happens, a
cardiac blood pool scan may be done
instead. It checks how well the left ventricle is
pumping. But it's not as good at finding
heart valve disease and a thick
heart muscle.

Tests also may be done to find areas of the heart that are not getting enough blood. These tests include:

As part of your ongoing treatment, your doctor will also try to
prevent or treat problems—such as fever,
arrhythmia, and
anemia—that can lead to
sudden heart failure. Treatment may include:

Getting vaccines. Your doctor may want you to get vaccines against
pneumonia and
flu. These vaccines can keep you from getting
infections that could put you in the hospital.

Checking your weight. Your doctor will probably give you
guidelines for watching fluid buildup and tell you how much weight gain is too
much.

Getting devices to fix heart rhythm problems. In some cases, your doctor may recommend a
biventricular pacemaker that is
placed in your chest to keep your heart beating at a normal rhythm. This is also called cardiac resynchronization therapy (CRT). Or you may
have an
implantable cardioverter-defibrillator (ICD) to stop a deadly rhythm. Some people get a pacemaker that is combined with an
ICD.

Cardiac rehabilitation, a supervised program that uses exercise, education, and support to help people recover from heart problems. For more
information, see the topic
Cardiac Rehabilitation.

Sometimes
heart failure can be fixed if another problem can be corrected, such as
by treating hyperthyroidism.

End-of-life care

Because heart failure tends to get worse over
time, it's important to think about what kind of care you would like at the end
of your life. It's also important that your doctor and family know what you
want.

An advance directive is a
legal document that tells doctors how to care for you at
the end of your life. To learn more, see
End-of-Life Decisions.

Prevention

The
best way to prevent
heart failure is to have a healthy lifestyle and control existing health problems like high blood pressure and diabetes.

To reduce your risk:

Don't smoke. If you
smoke, quit. Avoid
secondhand smoke too.

Lower your cholesterol. If you have
high cholesterol, follow your doctor's advice for
lowering it. Eating a heart-healthy diet—such as the
TLC diet—exercising, and quitting
smoking will help keep your cholesterol low.

Control your blood pressure. Exercising,
limiting alcohol, and controlling stress will help keep your blood pressure in
a healthy range.

Get regular exercise. Exercise will help
control your weight, blood pressure, and stress. Controlling these things will help keep
your heart healthy. Try to do activities that raise your heart rate. Aim
for at least 2½ hours of
moderate exercise a week.1

Control diabetes. Take your medicines as directed, and
work with your doctor to make a diet and
exercise plan to control diabetes.

Limit alcohol. If you drink alcohol, drink
moderately. This means no more than 2 drinks a day for men
and 1 drink a day for women.

Living With Heart Failure

You can feel better when you have heart failure by taking your medicines as directed, having a healthy lifestyle, and avoiding things that make heart failure worse. Know what things you can do every day to stay healthy, what symptoms to watch for, and when to call a doctor.

Take a low-dose aspirin every day if your doctor advises it to prevent a
stroke or heart attack. But higher doses of aspirin may make your heart failure
worse. So talk to your doctor first about how much to
take.

Having a healthy lifestyle

Limit sodium. Your doctor might recommend that you limit sodium to less than 2,000 mg a day. Limiting sodium can help you feel better and prevent sudden heart failure. Too much sodium makes it harder for your already-weakened heart to pump. Fluid may build up in your lungs—making it harder for you to breathe—and in your feet, ankles, legs, and belly.

Exercise regularly. If
you aren't already active, your doctor may want you to start
exercising. Do not start exercising until you have talked with your doctor to make an exercise program that is safe for you. You could do it in a cardiac rehabilitation program or on your own.

Avoiding things that make heart failure
worse

Treating your sleep problems

One Man's Story:

Pete, 70

"I was having a lot of trouble getting enough sleep. I
was snoring so bad that my wife was sleeping in another room. I'd wake up 7
times a night. Sometimes I'd wake up gasping for breath. The next day I'd be so
tired that I'd fall asleep while doing my woodworking in the garage. And I was
really fuzzy-headed. I couldn't remember anything.

"I thought it
might be my heart failure. So I decided to talk to my doctor about it, and he
suggested a sleep study. I found out that I have sleep apnea. I haven't been
getting enough oxygen because of it. He put me on a CPAP machine at night. I've
used it for the past 4 months.

"It took a little time to get used
to sleeping with a mask. But I'm sleeping much better. Now if I wake up, it's
only once, and I go right back to sleep. I feel so much better during the
day."—Pete

This story is based on information gathered from many people living with heart failure.

Many people with heart failure have trouble
sleeping. Your doctor may be able to find out what is causing your
sleep problems and help you get a good night's
sleep.

Other things you can do to take care of
yourself

Get help for depression and anxiety if you have them. Heart failure can be hard on your
emotions. Many people with heart failure feel
depressed or anxious. For more information on how to feel better, see
Coping With Your Feelings.

Help for caregivers

It can be rewarding to help a loved one with heart failure. But
it's also a lot of work. And it can be hard emotionally.

If you are taking care of a loved one, make sure that you also take
care of yourself. This can mean taking breaks by getting help from family or
friends. You also may be able to use respite care. These services provide
someone who will stay with your loved one while you get out of the house for a
few hours.

More information

Coping With Your Feelings

Heart failure
brings big changes to your life. You may struggle with sadness and worry. You
may wonder if you'll still be able to enjoy your life. Coping with your
feelings and seeking help when you need it can help you live better with heart
failure.

Depression and anxiety

Heart failure can be hard on your
emotions. You may feel
depressed that you can't do some of the things you
used to do. You may worry about your future. And symptoms of heart failure,
such as shortness of breath, can make this
anxiety worse.

These feelings are common.
Talk to your doctor if you have
symptoms of depression or are worried a lot.
Depression and anxiety can be treated with counseling and medicine.

You also can help yourself feel better by
changing your "self-talk." Those are the things you tell yourself about how
you're coping. Negative thoughts can make you feel bad. Changing the way you
think can change the way you feel.

Stress

The challenges of living with heart
failure can increase your stress. And stress can make living with heart failure
even harder. Stress also can disturb your sleep and make depression and anxiety
worse. Explore ways to relax and manage stress to help your body, mind, and
spirit.

Getting support

Emotional support from friends and family can help you cope with the struggles
of heart failure. You might want to think about joining a heart failure support
group. Ask your doctor about the types of support that are available where you
live.

Meeting other people with the same
problems can help you know you're not alone. If you're shy or aren't a joiner,
you can look at an online support group. Even though people online aren't
talking face-to-face, they're sharing their feelings and creating a
community.

Medications

You probably will need to take
several medicines to treat
heart failure, even if you don't
have symptoms yet.

Medicines don't cure heart failure. But
they can help your heart work better and improve symptoms.

The medicines you take
will depend on the type of heart failure you have. Some of the medicines treat
the heart's pumping problems (systolic heart
failure), while others treat problems with filling (diastolic heart failure). The most commonly used
medicines are listed below.

Other Treatment

Pacemakers

Cardiac resynchronization therapy (CRT) uses a biventricular pacemaker, which makes the
heart's lower chambers (ventricles) pump in the right
order.
This type of pacemaker
can help you feel better so you can be more active. It also can help keep you
out of the hospital and help you live longer.

If you get a pacemaker, you have to be careful
not to get too close to some devices with strong magnetic or electrical fields.
These include
MRI machines, battery-powered cordless power tools,
and CB or ham radios. But most everyday appliances are safe.

Implantable defibrillators (ICDs)

Implantable cardioverter-defibrillators (ICDs) can
prevent sudden death from an abnormal heart rhythm and may help you live
longer. An ICD checks the heart for very fast
and deadly heart rhythms. If the heart goes into one of these
rhythms, the ICD shocks it to stop the deadly rhythm and
returns the heart to a normal rhythm.

If you get an ICD, you have to be careful not
to get too close to some devices with strong magnetic or electrical fields.
These include
MRI machines, battery-powered cordless power tools,
and CB or ham radios. But most everyday appliances are safe.

Ventricular assist devices (VADs)

Ventricular assist devices (VADs), also known as heart
pumps, may be placed into the chest to help the heart pump
more blood.
VADs can keep people alive until
a donor heart is available for transplant. In some cases, VADs may also be used
as an alternative to heart transplant for long-term treatment. VADs are used in people who have severe heart failure.

Intra-aortic balloon pump

Supplements

You may still hear
about supplements that might improve heart failure
symptoms. But no supplement or vitamin has been shown definitely to relieve heart
failure or help you live longer.

Examples include coenzyme Q10, fish oil, and hawthorn.

Only some of the studies of coenzyme Q10 showed that it helps heart
failure symptoms.2

Fish oil supplements have not been shown to definitely help heart failure patients feel better or live longer. But eating fish that have a lot of omega-3 fatty acids, like tuna and salmon, is part of a heart-healthy diet.

Hawthorn is an herb that is sometimes used in Europe and Asia
to try to increase blood flow to the heart.

Talk
to your doctor before you take any over-the-counter medicine or
supplement. They are used along with medical treatments for heart failure, not instead of treatment.

End-of-Life Decisions

Palliative care

As your heart
failure gets worse, you may want to think about
palliative care. It's a kind of
care for people who have illnesses that don't go away and often get worse over
time. It's different than care to cure your illness. But
some people combine both types of care.

Palliative care:

May improve your quality of life—not just in your body, but also in your mind and
spirit.

May help you manage symptoms or side
effects from treatment.

Can help you cope
with your feelings about living with a long-term illness.

Can help you make plans around your medical
care.

Can help your family better understand
your illness and how to support you.

If you are interested in palliative care, talk to
your doctor. He or she may be able to manage your care or refer you to a doctor
who specializes in this type of care.

End-of-life care

Heart failure tends to get worse over time. So you
need to decide what kind of care you want at the end of your
life.

It can be hard to have talks with your
doctor and family about the end of your life. But making these decisions now
may bring you and your family peace of mind. Your family won't have to wonder
what you want. And you can spend your time focusing on your
relationships.

You will need to decide if you want
life-support measures if your health gets very bad. An
advance directive is a legal document that
tells doctors how to care for you at the end of your life.
This care includes electronic devices that are used for heart failure, such as pacemakers. You also can say where you want to have care. And you can name
someone who can make sure your wishes are followed.

Other Places To Get Help

Organizations

American Heart Association (AHA)

7272 Greenville Avenue

Dallas, TX 75231

Phone:

1-800-AHA-USA1 (1-800-242-8721)

Web Address:

www.heart.org

Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.

Heart Failure Society of America

Court International, Suite 240 S

2550 University Avenue West

Saint Paul, Minnesota 55114

Phone:

(651) 642-1633

Fax:

(651) 642-1502

Email:

info@hfsa.org

Web Address:

www.abouthf.org

The Heart Failure Society of America provides
information and education for people with heart failure and their families. The
Web site has education modules designed to help people with heart failure,
their loved ones, and individuals at risk to work better with their doctors or
nurses.

Heart Rhythm Society

1400 K Street NW

Suite 500

Washington, DC 20005

Phone:

(202) 464-3400

Fax:

(202) 464-3401

Web Address:

www.hrsonline.org

The Heart Rhythm Society provides information for
patients and the public about heart rhythm problems. The website includes a
section that focuses on patient information. This information includes causes,
prevention, tests, treatment, and patient stories about heart rhythm problems.
You can use the Find a Specialist section of the website to search for a heart
rhythm specialist practicing in your area.

HeartHub for Patients

Web Address:

www.hearthub.org

HeartHub for Patients is a website from the American Heart
Association. It provides patient-focused information, tools, and resources
about heart diseases and stroke. The site helps you understand and manage your
health. It includes online tools that explain your risks and treatment options.
The site includes articles, the latest news in health and research, videos,
interactive tools, forums and community groups, and e-newsletters.

HeartHub for Patients also links to Heart360.org, another American Heart Association
website. Heart360 is a tool that helps you send and receive medical
information with your doctor. It also helps you monitor your health at home. It
gives you access to tools to manage and monitor high blood pressure, diabetes,
high cholesterol, physical activity, and nutrition.

National Heart, Lung, and Blood Institute
(NHLBI)

P.O. Box 30105

Bethesda, MD 20824-0105

Phone:

(301) 592-8573

Fax:

(240) 629-3246

TDD:

(240) 629-3255

Email:

nhlbiinfo@nhlbi.nih.gov

Web Address:

www.nhlbi.nih.gov

The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
and treating:

Diseases that affect the blood, such as anemia,
hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.

National Institutes of Health Senior
Health

9000 Rockville Pike

Bethesda, MD 20892

Phone:

1-800-222-2225 Aging Information Center

TDD:

1-800-222-4225

Email:

custserv@nlm.nih.gov

Web Address:

www.nihseniorhealth.gov

This website for older adults offers aging-related
health information. The website's senior-friendly features include large
print, simple navigation, and short, easy-to-read segments of information. A
visitor to this website can click special buttons to hear the text aloud, make
the text larger, or turn on higher contrast for easier viewing.

The
site was developed by the National Institute on Aging and the National
Library of Medicine, both part of the National Institutes of Health
(NIH). NIHSeniorHealth features up-to-date health information from NIH. Also,
the American Geriatrics Society provides independent review of some of the
material found on this website.

Hunt SA, et al. (2009). 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 119(14): e391–e479.

Riegel B, et al. (2009). State of the science. Promoting self-care in patients with heart failure. A scientific statement from the American Heart Association. Circulation, 120(12): 1141–1163.

Schocken DD, et al. (2008). Prevention of heart failure: A scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group.

Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.

Somers VK, et al. (2008). Sleep apnea and cardiovascular disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing in collaboration with the National

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